If you have IBD, your diarrhoea may be due to a flare up of your disease -although there are also some other factors which may be causing the diarrhoea or making it worse.
Side effects of drugs for IBD
One of the rare side effects of 5-ASAs such as mesalazine and sulphasalazine, is watery diarrhoea. You may be able to reduce this side effect by taking the tablets with or after food. Some of the immunosuppressants, such as azathioprine and methotrexate, can also cause diarrhoea especially during the early weeks of treatment. Talk to your doctor or IBD team about ways to manage this, or see our Drug Treatment leaflets, Azathioprine and Methotrexate, for further information.
Side effects of other drugs
You may also find it helpful to check whether diarrhoea is a side effect of any other medications you are taking. Antibiotics and acid-lowering treatments such as omeprazole and lansoprazole can also cause diarrhoea.
Colectomy and ileo-rectal anastomosis
In this operation the colon is removed and the ileum (the lower part of the small intestine) joined directly to the rectum. After this procedure your faeces will tend to be much more liquid because you no longer have a colon to absorb the water.
Small Bowel Surgery for Crohn’s Disease
If you have had the end of the ileum (the lower part of the small intestine) removed, you may have bile salt diarrhoea. Bile salts are produced in the liver and are usually reabsorbed in the ileum, so that only very small
amounts enter the colon. However, if part of the ileum is lost, much higher levels of bile salts can drain into the colon. This can irritate the colon causing watery diarrhoea. Inflammation of the end of the ileum can also lead to bile salt diarrhoea as well as to poor fat absorption (see below).
Malabsorption of fats
If you have Crohn’s in the ileum (the lower part of the small intestine) you may have difficulty absorbing fats. This can lead to urgency and to pale and bad smelling, poorly formed faeces that are difficult to flush away.
Iron Supplements
You may be prescribed iron supplements for anaemia caused by your IBD. A change in bowel habit is a common side effect of iron supplements and while some people get constipation, others get diarrhoea.
Irritable Bowel Syndrome (IBS)
IBS is sometimes confused with Inflammatory Bowel Disease, but is a separate and different condition. Some of the typical symptoms of IBS, such as diarrhoea and colicky pain, can be very similar to those of IBD, but IBS does not cause inflammation or bleeding. However, it is possible that some people with UC or Crohn’s Disease may have irritable bowel symptoms as well as IBD – probably because the inflammation has temporarily affected the nerve endings in the bowel. So they may, for example, continue to experience diarrhoea following an IBD flare up, even once the inflammation has died down.
Diet and food sensitivities
Some people are sensitive to particular foods, such as milk and wheat. Too much fibre, spicy food, chocolate, caffeine (in coffee, tea and cola drinks), alcohol, fructose (a sugar in fruit) and artificial sweeteners (sorbitol) can all have a laxative effect, stimulating and loosening the bowels. Intolerance to lactose, a natural sugar found in milk, can also cause diarrhoea.
Infections
In people without IBD, diarrhoea is often a sign of gastroenteritis – an infection of the large bowel, commonly caused by a virus or bacteria. These infections can also affect people with IBD and your doctor or IBD team may carry out tests to make sure your diarrhoea is not at least partly due to such an infection.
For more information see our leaflet Managing Diarrhoea.
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